FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[READER SHOULD SEE GYNECOLOGIST ABOUT HER POST-MENOPAUSAL BLEEDING]

[Editor's note: Nov. 1 to Nov. 7 is National Osteopathic Medicine Week. The theme this year is "Needs of the Post-menopausal Woman." This column is our way of contributing to this annual celebration of the osteopathic profession.]

Question: I am 53 years old, and I haven't had regular menstrual periods for about 2 years now. I'm concerned because I just finished a light period. One of my friends tells me that this is to be expected, while another thinks I should go see my doctor. What should I do?

Answer: Most women go through menopause between the ages of 45 and 53. This is often an unceremonious event. She simply stops having periods. Other women have some irregularity to their menstrual cycle for the last months, skipping a month or two, then having another period. A delay of 24 months since the last period is quite uncommon, however, so I'll cast my vote with your friend who recommended that you see your doctor.

There are a number of conditions that can cause bleeding from the uterus after menopause. The most frightening of these is cancer of the uterus. Fortunately, there is a greater than 96 percent chance that this is not the cause, but the consequences of this dreaded disease are so serious that every woman with postmenopausal bleeding should be evaluated for it.

A routine Pap test is very inaccurate for identifying the cause of uterine bleeding instead, it is good at identifying cervical cancer. A test that obtains a tissue sample from inside the uterus is needed to evaluate abnormal uterine bleeding. There are several tests that can be done in the office, but unfortunately, the small sample of tissue they obtain may or may not be adequate to identify the cause of bleeding. A doctor conducting this type of tissue sampling test is often aided by an ultrasound image of the uterus. This helps identify variations in the muscle wall and the softer mucosal lining of the uterus.

In some situations a more complete evaluation of the uterine lining may be necessary. The best method for accomplishing this goal is a surgical procedure known as a "D&C" that is usually done at a hospital on an outpatient basis. During this procedure the doctor may also use an instrument called a hysteroscope to look inside the uterus.

Postmenopausal uterine bleeding is often the consequence of stimulation of the uterine lining by hormone imbalance. This may be the result of natural fluctuations in hormone levels or as a consequence of taking estrogen replacement therapy. If the problem is natural hormone fluctuations, taking supplemental amounts of hormone to restore the normal balance usually stops the bleeding. However, if the bleeding is caused by supplemental hormones, the proper course of action is usually to stop taking the hormones. Non-cancerous uterine tumors called uterine fibroids can also cause bleeding, but they typically do this before menopause, rather than after it. There are a variety of other causes for post-menopausal uterine bleeding. I'd suggest that you see your gynecologist to find out what is causing your bleeding.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.